Children's Lack of Sleep Is a Hidden Health Crisis

It’s recommended that school-age children get nine to 11 hours of sleep a night, while teens need eight to 10. Preschoolers and toddlers need even more to function optimally — ranging from 10 to 14 hours a night.1 But many kids are falling short on fulfilling this basic need, putting their physical and mental health at risk.

In England, sleep disorders among children are also on the rise, an investigation by The Guardian revealed. The number of children and teens aged 16 years and under admitted to a hospital due to a sleep disorder rose from about 6,500 in 2012-2013 to nearly 9,500 in 2017.2 Most of the admissions were due to sleep apnea, with 8,274 admissions alone in 2017-2018.

Why Are Children Finding It Hard to Sleep?

One of the joys of childhood should be the ability to drift off to sleep without a care in the world, or at least without the difficulty that plagues many adults. Children, however, may be kept awake at night due to anxiety over everything from school and peer pressure to social media and terror incidents.

At one private sleep clinic in London, The Guardian reported there had been a 30 percent rise in anxiety-related referrals for sleep issues among children in the past year alone.3 Not only can anxiety make sleep difficult, but — in a vicious cycle — lack of sleep can trigger more anxiety.

Practical issues may also be playing a role. With parents sometimes working late, children may not have regular bedtimes or bedtime routines that are conducive to sleep.

Vicki Dawson, founder of The Children’s Sleep Charity, which provides support to families for children’s sleep, told The Guardian, “We are increasingly seeing families where both parents are out working and this can mean that bedtime becomes later, bedtime routines may be rushed or abandoned all together … A good sleep routine is key in supporting a better sleep pattern.”4

Dawson mentioned dietary issues as well, including excessive sugar consumption or intake of energy drinks that children may consume because they’re tired during the day. Both can interfere with getting a sound night’s sleep. This ties in with obesity, another factor that may be influenced by diet and which can significantly interfere with sleep.

Is Obesity to Blame for Kids’ Sleep Problems?

In the U.S., over 18 percent of teens and nearly 14 percent of young children are obese,5 which raises the risk of sleep apnea. The most common type of sleep apnea is obstructive sleep apnea (OSA), which causes the airway to become blocked during sleep, leading to reduced or blocked airflow.

If a child is obese, there’s extra stress put on the upper airway, which can cause it to collapse, leading to sleep apnea. Left untreated, pediatric sleep apnea can lead to:6

Behavior issues such as hyperactivity and poor impulse control

Cognitive dysfunction and inattentiveness

Heart disease later in life, especially if the child is, and continues to be, obese

As such, many of the behavior problems and learning difficulties attributed to ADHD might actually be consequences of chronic fragmented sleep. Further, there are other contributors to sleep apnea in children aside from obesity. One of the first may be lack of breastfeeding, as breastfeeding longer than one month is linked to a lower risk of habitual snoring and apneas.

Researchers believe there may be a “beneficial effect of the breast in the mouth on oropharyngeal [middle part of the throat, behind the mouth] development with consequent protection against upper airway dysfunction causing sleep-disordered breathing.”8

It’s thought that breastfeeding helps expand the size of the child's palate and shift the jaw forward, helping prevent sleep apnea by creating enough room for unobstructed breathing. That being said, if your child is obese, losing weight can dramatically improve sleep apnea (and therefore overall sleep quality) by reducing pressure on the abdomen and chest, thereby allowing the breathing muscles to function more normally.

Obesity is another double-edged sword in that it may contribute to sleep problems while lack of sleep may also contribute to obesity. Michael Farquhar, a consultant in sleep medicine at the Evelina London Children’s Hospital, told The Guardian:9

“We have two main epidemics among children. One is obesity and the other is mental health, and underpinning both of these is sleep … We always thought sleep was a consequence of obesity but there is an increasing understanding that sleeplessness contributes to obesity.

When you are sleep-deprived, your body responds by altering the hormones that affect appetite and hunger … you crave unhealthy things when you are tired.”

US Teens Short on Sleep: Could Later School Start Times Help?

According to a Sleep in America Poll, 58 percent of teens average only seven hours of sleep a night or less,10 which is significantly less than the recommended eight to 10. One challenge is certainly electronics, with many teens staying up late to browse social media or play video games. However, teens are also wired with different sleep and wake patterns, which favor staying up late and getting up later.

Despite this, many middle and high schools start the day as early as 7 a.m., leaving teens little chance to sleep in. One National Sleep Foundation poll revealed that 60 percent of kids aged 18 and under say they’re tired during the day while 15 percent said they’ve fallen asleep at school.11

They’re now urging educators to use later school start times for teens to facilitate better sleep, along with adopting sleep education curriculum to teach students about the importance of sleep and the negative effects of getting too little.

Mary Carskadon, director of the Chronobiology and Sleep Research Laboratory at E.P. Bradley Hospital in East Providence, Rhode Island, told ABC News, “Teenagers are getting way too little sleep … They are being asked to get up at the wrong time. They are being asked to be in school when their brains are asleep.”12

In 2014, the American Academy of Pediatrics also issued a policy statement urging middle and high schools to delay the start of class to 8:30 a.m. or later in order to “align school schedules to the biological sleep rhythms of adolescents, whose sleep-wake cycles begin to shift up to two hours later at the start of puberty.”13 Dr. Judith Owens, lead author of the policy statement, explained:14

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life …

Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Why It’s Risky for Teens to Skimp on Sleep

Lack of sleep has major effects on health, performance, mood and more. At least one study suggests that teens who start school at 8:30 a.m. or later had improvements in academic performance, attendance and tardiness.

In a survey of over 9,000 high school students, the later start time allowed more than 60 percent of them to get eight hours of sleep a night, and the number of car crashes for teen drivers was reduced by 70 percent when a school changed its start time from 7:35 a.m. to 8:55 a.m. Further, the researchers reported:15

“Teens getting less than eight hours of sleep reported significantly higher depression symptoms, greater use of caffeine, and are at greater risk for making poor choices for substance use.”

What’s more, research suggests that high school students who sleep six hours or less each night are twice as likely to engage in risky behaviors as those who sleep for eight hours (and only 30 percent of the students in the study averaged eight hours of sleep a night).16 This includes:

Using alcohol, tobacco, marijuana or other drugs

Driving after drinking alcohol

Carrying a weapon

Being in a fight

Sleeping less than six hours a night was also linked to a threefold increased risk of considering or attempting suicide. Lead author Matthew Weaver, Ph.D., associate epidemiologist in the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, said in a news release:17

"We found the odds of unsafe behavior by high school students increased significantly with fewer hours of sleep … Personal risk-taking behaviors are common precursors to accidents and suicides, which are the leading causes of death among teens and have important implications for the health and safety of high school students nationally."

Electronics Play a Major Role in Childhood Sleep Issues

Electronics are a formidable force when it comes to childhood sleep quality, with 56 percent of the parents in one survey blaming them (including social media and cell phones) as the primary reason why their teen has trouble falling asleep or staying asleep.18

What’s more, among those teens with frequent or occasional sleep problems, 72 percent said their doctor had recommended turning off electronics and cell phones to address sleep problems. Exposure to LED-backlit computer screens or TVs at night significantly suppresses melatonin production and feelings of sleepiness.

When your brain “sees” blue light at night, the mixed message can add up to serious health issues. In 2011, for instance, researchers found that evening exposure to LED-backlit computer screens affect circadian physiology. Among 13 young men, exposure to five hours of an LED-lit screen at night significantly suppressed melatonin production along with sleepiness.19

If your child views screens at night, it’s therefore essential to block exposure to blue light while doing so. In the case of a computer, you can install a program to automatically lower the color temperature of the screen. Many use f.lux to do this, but I prefer Iris software for this purpose.

In addition, when watching TV or other screens, be sure to wear blue-blocking glasses after sundown. For children and teens, however, electronics should be shut off ideally at least one hour before bedtime and preferably as soon as it gets dark.

Top Strategies to Help Your Child Sleep

Sleep deprivation, or a lack of quality sleep, has a significant impact on your overall health and may lead to the following:

It’s therefore essential to help your child develop healthy sleep habits early on. If you believe sleep apnea is the issue, have your child evaluated by a professional to get a proper diagnosis and treatment plan. You may also have considered natural remedies like melatonin, but be aware that there are other options.

While occasional melatonin supplementation in healthy children may help sleep and is unlikely to cause harm, most sleep problems should be addressed via improved sleep hygiene and behavioral changes.

However, there is some evidence that melatonin supplementation may help children with autism, ADHD or other neurodevelopmental or psychiatric conditions.21 In particular, Canadian Family Physician suggested:22

Napping during the day should be avoided

Dinnertime should be at least two hours before bedtime

Screen time (watching television, playing computer or video games) should be discontinued at least one hour before bedtime

Regular bedtime routine including routine sleep and wake-up times should be maintained

Children should sleep in their own beds

Sleep environment should be dark and quiet; room should not be too hot

Caffeine, nicotine and alcohol should be avoided

In addition, I’d add installing blackout drapes in your child’s bedroom, avoiding exposure to blue light at night, having your child wear blue-light blocking glasses after the sun sets and getting exposure to bright light in the morning as much as possible to help reset your child’s circadian clock daily.

Even doing homework too late at night may make it difficult for your child to fall asleep, so try to have any responsibilities wrapped up early so your child has time to unwind before bed.

Being a good role model is also important, including limiting your own exposure to electronic devices and blue light at night, and finishing up your work prior to bedtime so you can be fully present and help your child through a relaxing bedtime routine.